Increasing evidence suggests that infection with cytomegalovirus (CMV)and other agents eg. Chlamydia, H.pylori, Hepatitis A etc. and elevated C reactive protein (CRP) levels are associated with atherosclerosis and worse outcome. We hypothesized that infections and subsequent inflammation mediate their atherogenic effect by promoting abnormal coronary endothelial and vasomotor function. We measured coronary vascular endothelium-dependent and -independent function with intracoronary acetylcholine and nitroprusside, and flow reserve with adenosine in over 200 patients. Blood samples were tested for a)cellular response (Tc+/-)to CMV using a T-cell proliferation assay and b)for antibody response(Ab+/-)by ELISA. In addition antibody titres to the other organisms were also tested. Results: The risk of CAD was higher in patients with increased pathogen burden. There appeared to be strong independent risk associated with prior Hepatitis A virus. There was also an association between the pathogen burden (number of infections) and CAD and hypertension. We are currently evaluating the effects of pathogens on coronary vascular endothelium-dependent and - independent responses. - cytomegalovirus, acetylcholine, nitroprusside, Chlamydia, Hepatitis A, C Reactive protein - Human Subjects